Aaron Lassmann

ISM-Period 7
FDA. "Computed Tomography (CT)." U.S. Food and Drug Administration. U.S. Food and Drug
Administration, 7 Apr. 2014. Web. 23 Mar. 2016.

Computed tomography (CT) is a noninvasive medical exam that produces cross-sectional

images of the body through the use of x-rays.
It is also sometimes known as computerized tomography or "computed axial
tomography" (CAT).
The cross-sectional images are like a slice of the person imaged. This commonly
compared to slices of bread.
The images can be used for various diagnosis and therapeutic regions. CT can be
performed on any area of the body.
CT scans are very prevalent in all medical settings and most commonly performed as an
outpatient procedure.
The patient is scanned on a motorized table which moves itself into the circular CT
machine. Inside the machine, an x-ray source and detector array quickly rotate around the
patient. Each rotation takes about one second.
During rotation the X-ray source produces a narrow, fan-shaped beam of X-rays that
passes through a section of the patient's body.
The detectors opposite of the source essentially detect the shadow created by the
absorption of x-rays by the patients body. Throughout each rotation, many different sots
of the patient are taken from various angles.
The images taken are sent to a computer where the various shots are compiled into the
cross-sectional images.
The thickness of the fan beam may be as small as 1 millimeter or as large as 10
millimeters. In typical examinations there are several phases; each made up of 10 to 50
rotations of the x-ray tube around the patient in coordination with the table moving
through the circular opening.
Contrast materials are often given or injected into the patient to highlight certain things
and improve the diagnostic quality of the images taken.
Most CT machines today are capable of spiral as well as the more conventional axial
scanning technique. Most are also now able to scan multiple images simultaneously.
Another advancement in the technology is electron beam CT, also known as EBCT.
Although the principle of creating cross-sectional images is the same as for conventional
CT, whether single- or multi-slice, the EBCT scanner does not require any moving parts
to generate the individual "snapshots." As a result, the EBCT scanner allows a quicker
image acquisition than conventional CT scanners.

This source provides a comprehensive and broad coverage of the basic technology behind CT
machines without sacrificing simple comprehension and readability, and this source will be
useful for information in my final presentation PowerPoint.

Aaron Lassmann
ISM-Period 7
Cierniak, Robert. "History of Computed Tomography." X-ray Computed Tomography in
Biomedical Engineering. London: Springer, 2011. 7-19. Print.

X-radiation was first discovered by Wilhelm C. Rntgen in 1895 while studying cathode
rays when he noticed glowing from a screen of fluorescent paper.
He placed multiple objects between the source and screen and discovered that it created
in an outline of the bones in his hand. He sent his discoveries to the Wrzburg Physical
Medical Society, and the discovery became a sensation. Rntgens success culminated in
1901 with the Nobel Prize, the first in history to be awarded for physics (10).
X-ray photographs allowed for internal observation without surgery, and the technique
rapidly spread across the medical world. X-ray equipment for two-dimensional images
improved in the following decades.
In 1916, [Doctor Karol Mayer from the Krakow Clinic of Internal Medicine] obtained
stratigraphic images using a moving X-ray tube and a stationary film cassette, a method
which resembles the process of scanning by computed tomography (12).
The development of advancing computer technologies and techniques allowed for
computed tomography to come into existence.
Allan MacLeod Cormack was born in South Africa and first encountered issues with
tomography while with the Department of Physics at the University of Cape Town and
working on the measurement of X-ray absorption in various body tissues.
Later, at Harvard in 1956, he began looking at the problem of image reconstruction of Xray projections. He solved the problem theoretically first and then confirmed it
experimentally in 1963.
Cormack was a theoretical physicist and was less concerned with the practical
applications of this. Englishman Godfrey Newbolds work led to the development of the
first CT scan, with his work starting independently of Cormack in 1967.
He initially used gamma radiation, which has similar properties to X-radiation. He also
found a different approach to image reconstruction by using computers to carry out the
complicated calculations.
Initial experiments did not produced images where healthy and unhealthy tissues could be
differentiated. After about 28 thousand measurements and a process of reconstruction
taking about 2.5 hours, an image was obtained with enough contrast to enable the
observation of the differences between the tissues of the brain (15).
During the clinical test phase, the gamma radiation was replaced with X-radiation,
shortening the time needed to take an image. In September 1971, a scanner was installed
at Atkinson Morleys Hospital in Wimbledon.

This source provided a very comprehensive history on all the developments that lead up to CT
scanners and the development of CT scanning itself, which will be very useful in my
presentation.

Aaron Lassmann
ISM-Period 7
Kumar, Panil, Kishor V. Hedge, A. Agrawal, and K. Rooparani. "Indications and Timing for CT
Scan in Traumatic Brain Injury and Analysis of CT Scan Findings." Narayana Medical
Journal 1.2 (2012): n. pag. ScopeMed. ScopeMed International Medical Journal
Management and Indexing System, Oct. 2012. Web. 28 Mar. 2016.

Trauma is a serious and major health problem and is the leading cause of death in persons
45 years and younger. Head injuries are the cause of death in most trauma cases.
The primary goal of trauma imaging is to identify any treatable problems before
secondary brain injury occurs. CT scans work ideally to evaluate trauma patients
immediately.
Estimates in the United States put the number of persons treated annually for head trauma
at more than 1.5 million.
Cranial CT scans are the most commonly performed radiological exam and are important
for diagnosing or viewing any structural damage to the brain. They remove the need for
angiography and other invasive diagnostic procedures.
A CT scan is probably recommended for all patients including patients with mild head
injury because one in five will have an acute lesion detectable by the scan (1-2).
Head trauma can be divided into primary lesions and secondary lesions. Primary lesions
occur at and are a direct result of the initial traumatic force. These can include fractures,
extra-axial hemorrhages, contusions, and intracerebral hematoma.
Secondary lesions occur as a result of a primary lesion. These are usually as a result of
mass effect such as cerebral edema, midline shift, herniations, or vascular compromise
(6).
The distinction between primary and secondary lesions is important because primary
lesions are often preventable.
The exposed position of the human scalp is what makes it prone to injury. Skull fractures
are generally the result of some sort of impact injury.
The shape of the damage depends on several factors, such as kinetic energy, the
elasticity of the impacting material and the area of impact (6).
Hemorrhages in the area include epidural, subdural and subarchnoid. Epidural hematoma
is the second most common lesion when it comes to acute head trauma.
This occurs when space forms between the skull and dura mater at suture lines, causing
arterial bleeding. This results in rapid neurological deterioration and require rapid
treatment.

This source is from a study that looked at using CT scans for acute trauma patients, providing
a good overview of information for both and data from a real patient set to look at and
compare the benefits and drawbacks of the scans for all trauma patients.

Aaron Lassmann
ISM-Period 7
Xavier, Andrew R., et al. "Neuroimaging of Stroke: A Review." Southern Medical Journal 96.4
(2003): n. pag. Medscape. WebMD LLC, 2003. Web. 28 Mar. 2016.

Over the past 30 years advances in neuroimaging have led to an explosion in its use and
in the amount of imaging that can be easily obtained. This expansion has resulted in a
better medical understanding of cerebrovascular and tissue pathology and greater
treatment and prevention measures.
Stroke is major source of death and disability throughout the world. The diagnosis of it
originally depended on bedside methods. Knowledge of its localization and nature could
only be confirmed after a patients death, hampering the ability to develop interventions.
Advances include early and accurate detection of ischemic and infarcted tissue and also
the ability to reveal hypoperfused tissue at risk. Clinicians are increasingly able to
noninvasively detect embolic and atherothrombotic intravascular lesions (1).
CT images of the brain are created through a scan by collimated beam of x-rays in thin
slices. The data gathered can then be analyzed and compiled by a computer into readable
images. Newer machines use spiral technology to allow for constant and faster imaging
of a patient.
CT scans are the preferred imaging method for hyperacute stroke. They can be performed
on patients with a pacemaker, on a ventilator, or that are confused and delirious.
Additionally, CT scans of hyperacute strokes are relatively straightforward to read and do
not require any special or specified training.
When it comes to hyperacute stroke, CT is not sensitive enough to identify cerebral
infarction, but it can identify acute intracranial hemorrhage and other lesions that could
prevent the utilization of thrombolytic therapy.
Hemorrhaging can be identified by the loss of gray-white interface in the CT image,
indicating the leakage and perfusion of blood into the area. Hypodensity can also be
indicated on the scan.
Chronic infarctions are characterized by marked hypodensity and lack of mass effect on
CT scans; the density is similar to cerebrospinal fluid (2).
Acute blood clots and subarachnoid hemorrhage appear hyperdense on CT, often greatly
contrasting with the surrounding brain matter.
Magnetic resonance imaging (MRI) has replaced CT for head scans in many cases of
stroke due to improved image sensitivity, faster scans, and no radiation.
MRI is however more expensive, not as widely available, and cannot scan all patients,
such as those with pacemakers.

This article from the Southern Medical Journal and provides a general and comprehensive
overview of the different types of imaging used in stroke diagnosis, along with relevant
labeled pictures to assist in comprehension.

Aaron Lassmann
ISM-Period 7
Fink, Kathleen R., and James R. Fink. Imaging of Brain Metastases. Surgical Neurology
International 4.Suppl 4 (2013): S209S219. PMC. Web. 31 Mar. 2016.

Imaging is key in identifying and diagnosing any possible malignant metastases in the
central nervous system (CNS) of the body.
It is used in patients with known malignancies, new neurological signs or symptoms, and
patients with known cancer that may spread.
MRI and CT are the two primary modes for the identification and diagnosis of any brain
metastasis. More advanced imaging methods like proton magnetic resonance
spectroscopy (MRS), contrast enhanced magnetic resonance perfusion (MRP), diffusion
weighted imaging (DWI), and diffusion tensor imaging (DTI) may also be used.
Although magnetic resonance imaging (MRI) is more sensitive than computed
tomography (CT) for detection of brain metastases, CT remains a vital tool for initial
work-up and perioperative management (2).
The advanced forms of imaging mentioned above are used to distinguish a brain
metastasis from other pathologies and to monitor response to treatment.
15 to 40% of patients with cancer experience brain metastasis, and many of these are
asymptomatic.
Metastasis is associated with cancers, such as lung, breast, skin, colon, pancreas, testes,
ovary, cervix, renal cell carcinoma, and melanoma. However, it has also been reported in
other various forms of cancer.
CT without contrast is generally the first mode used on patients with new neurological
issues because it is easy to do, easily tolerated, and can quickly rule out anything
immediately life-threatening, like hemorrhage or hydrocephalus. CT with contrast or an
MRI may later be used to evaluate after initial diagnosis.
For up to 60 to 75% of cases, brain metastasis can be asymptomatic. Additionally, the
presence of brain metastasis can alter treatment methods.
CT without contrast may performed for a variety of reasons. It is not sensitive enough to
screen for cerebral metastases, but the study may suggest that as the diagnosis.
Metastases may appear as a singular lesion or multiple and can appear at any density
level relative to the brain in the absence of any hemorrhage.
A hemorrhagic metastasis will appear as hyperdense in comparison to the brain, while a
metastasis from melanoma will be hypodense in comparison.
Iodinated contrast enhancement is very important in imaging and detecting metastases.
CT with contrast has been shown to be more sensitive than MRI without contrast when it
comes to cerebral metastases. Additionally,

This source is very in depth about the various types of imaging for brain metastases, describing
and comparing them with each other to emphasize their respective roles, which is very useful
for my own understanding and for making these distinctions in my final presentation.